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It sounds like she is not in CHF. based upon what you quoted from the cardiologist's report. Stage B2 is not CHF. Stage C is CHF.

Originally Posted by cwaters

... I wish I knew conclusively what the cause of the cough is. It's still not something we hear often; we listen for it, but notice it only once or twice a day.

I gather the vet thinks it is air-passage-related. That is why she wrote: "Consider work-up for soft palate / upper airway issues."

Originally Posted by cwaters

... Now that she's been on it for almost two weeks, I'm wondering whether the medication is truly needed (the cardiologist says it is), why it's being changed (halving the Furosemide; doubling the Enalapril) (I didn't really understand the cardiologist's explanation--even after she repeated it numerous times), and whether the new amounts are safe (the cardiologist assured me it is). Perhaps most importantly, I'm wondering how to know if the medication is helping Freckles' condition.

I don't think that the medications are going to do damage. I would like to know what her explanation is for prescribing them, in view of the consensus statement among cardiologists and the two studies I quoted in the post earlier today.

As for if and when your dog enters CHF, there is a blog entry posted just yesterday on CavalierHealth.org Blog that explains how you can tell. It is titled: "Do-it-yourself diagnosing of congestive heart failure in your cavalier King Charles spaniel". Here is a link to it: http://cavalierhealth.org/blog.htm#June_18,_2014

I gather the vet thinks it is air-passage-related. That is why she wrote: "Consider work-up for soft palate / upper airway issues."

Freckles has always been a loud snorer/snorter; indeed, the cardiologist's comments sound like a description of a long-standing, chronic problem. But that wouldn't explain why the cough began only recently. Perhaps tomorrow's CBC blood test will help identify the cause.

If the cough isn't being caused by something bacterial or viral, I guess the only thing else it could be is an allergy or MVD (i.e., due to fluid in the lungs). If it's the latter, shouldn't the medication be helping alleviate that, and the cough...and if it's not alleviating it (after being on the medication for two weeks already) does that bring the MVD stage and/or prescribed medication and dosage (especially the *lowering* of the Furosemide amount) into question?

Exasperating the problem, the pharmacy's paperwork for Enalapril says that it (itself) can cause a dry cough!

Originally Posted by RodRussell

I don't think that the medications are going to do damage. I would like to know what her explanation is for prescribing them, in view of the consensus statement among cardiologists and the two studies I quoted in the post earlier today.

As for if and when your dog enters CHF, there is a blog entry posted just yesterday on CavalierHealth.org Blog that explains how you can tell. It is titled: "Do-it-yourself diagnosing of congestive heart failure in your cavalier King Charles spaniel". Here is a link to it: http://cavalierhealth.org/blog.htm#June_18,_2014

The blog entry is very helpful; thank you!

Freckles' respiratory rate while sleeping is consistently ~20. Based on just the blog entry, it seems that prescribing medication may have been premature. Although I appreciate our cardiologist's efforts, I'm now wondering whether I should get a second opinion. When I asked the cardiologist why she prescribed the medication (and why she is keeping her on it, though with some adjustments), she simply said that she recommends it, given her condition. I don't know; maybe I'm being too picky/critical. I have to remind myself that this is an inexact science, and that there are many variables. (BTW, when I asked about her experience with Cavaliers, she said that she has treated many.)

Sorry if it seems I'm going round and round on this. The uncertainties are frustrating, especially considering the short/long-term effects of the decisions that are currently being made.

Freckles has always been a loud snorer/snorter; indeed, the cardiologist's comments sound like a description of a long-standing, chronic problem. But that wouldn't explain why the cough began only recently. Perhaps tomorrow's CBC blood test will help identify the cause.

If the cough isn't being caused by something bacterial or viral, I guess the only thing else it could be is an allergy or MVD (i.e., due to fluid in the lungs). If it's the latter, shouldn't the medication be helping alleviate that, and the cough...and if it's not alleviating it (after being on the medication for two weeks already) does that bring the MVD stage and/or prescribed medication and dosage (especially the *lowering* of the Furosemide amount) into question?

Exasperating the problem, the pharmacy's paperwork for Enalapril says that it (itself) can cause a dry cough!

Yes, enalapril reportedly can cause a cough similar to a cardiac cough, although that apparently is not a frequently noted symptom in cavaliers.

Originally Posted by cwaters

Freckles' respiratory rate while sleeping is consistently ~20. Based on just the blog entry, it seems that prescribing medication may have been premature. Although I appreciate our cardiologist's efforts, I'm now wondering whether I should get a second opinion. When I asked the cardiologist why she prescribed the medication (and why she is keeping her on it, though with some adjustments), she simply said that she recommends it, given her condition. I don't know; maybe I'm being too picky/critical. I have to remind myself that this is an inexact science, and that there are many variables. (BTW, when I asked about her experience with Cavaliers, she said that she has treated many.)

I would ask her to explain her position about these drugs with your dog prior to CHF in as layman-like words as possible. Tell her that you've read about the side effects of the two drugs and are concerned about whether they are needed at your dog's stage. For example, if you dog does have some excess fluid retention, even though she is not in CHF, then the diuretic would be appropriate. And since diuretic alone can harm the kidneys, the enalapril could be given to moderate those possible affects (although benazepril, another ACE-inhibitor, is reportedly easier on the kidneys than is enalapril).

If she was my dog, I would get a second opinion only as a last resort in this case because the pre-CHF prescription of enalapril is not unusual, but just not the majority opinion. Have you taken a look at the ACVIM cardiologists' "Consensus Statement" on diagnosing and treating MVD? Here is a link to it: http://cavalierhealth.org/images/acv...ccvhd_2009.pdf
It is a little tedious to read, so here are a couple of tips: On page 1143, in the second column, there is a list describing the various stages of MVD. Beginning on page 1144, there are the descriptions of diagnosing and treating each stage. I believe your dog is at Stage B2, so that is where you could start reading.

The paperwork from the pharmacy is applicable for humans and not for dogs. For dogs, you would want to look at something like Plumb's Veterinary Drug Handbook. I never use pharmacy paperwork when looking for side effects of drugs in dogs; I always use a veterinary resource.

The chronic dry cough from ACE inhibitors is VERY common in humans. I can't take any ACE-I or ARB drug without sounding like I am a chronic smoker (have never smoked). The drug side effect cough is CONSTANT and extremely annoying. This has been a big problem for me since I take drugs for mild hypertension. Very quickly after I stopped these drugs, the cough totally disappeared.

This symptom is very rare for dogs. In 25 years, I've only known of one dog that exhibited this side effect from enalapril.

I would ask her to explain her position about these drugs with your dog prior to CHF in as layman-like words as possible. Tell her that you've read about the side effects of the two drugs and are concerned about whether they are needed at your dog's stage. For example, if you dog does have some excess fluid retention, even though she is not in CHF, then the diuretic would be appropriate. And since diuretic alone can harm the kidneys, the enalapril could be given to moderate those possible affects (although benazepril, another ACE-inhibitor, is reportedly easier on the kidneys than is enalapril).

If she was my dog, I would get a second opinion only as a last resort in this case because the pre-CHF prescription of enalapril is not unusual, but just not the majority opinion. Have you taken a look at the ACVIM cardiologists' "Consensus Statement" on diagnosing and treating MVD? Here is a link to it: http://cavalierhealth.org/images/acv...ccvhd_2009.pdf
It is a little tedious to read, so here are a couple of tips: On page 1143, in the second column, there is a list describing the various stages of MVD. Beginning on page 1144, there are the descriptions of diagnosing and treating each stage. I believe your dog is at Stage B2, so that is where you could start reading.

Thank you for the references and recommendations. Very helpful. I'll ask the cardiologist those questions.

I'm troubled that, after being on the original diuretic dosage for a full week and half the dosage for another week, Freckles' occasional cough hasn't improved. I was able to record the cough this morning; here is the WAV file: https://drive.google.com/file/d/0B0c...it?usp=sharing

Freckles had her CBC and kidney-related blood work this morning. I expect to hear back from the vet and/or the cardiologist by Monday. Her 'at rest' sleep breathing continues to be good (about 20 per minute).

...I never use pharmacy paperwork when looking for side effects of drugs in dogs; I always use a veterinary resource....[Coughing from Enalapril] is very rare for dogs. In 25 years, I've only known of one dog that exhibited this side effect.Pat

Thank you for the information, Pat. Freckles' cough began a few weeks before she was prescribed Enalapril; good to know it's unlikely to be contributing factor.

Freckles has now been on Furosemide and Enalapril for two weeks. The coughing doesn't seem to have improved or worsened. Please see the post immediately before this one to listen to a recording of it. It sounds like a two-part cough; almost like a hiccup, but definitely a cough.

... I was able to record the cough this morning; here is the WAV file: ...

That is quite an odd cough. It sounds very deep and hoarse. Coughs due to MVD typically are because of fluid in the lungs or the very enlarged heart impinging upon the breathing apparatus. So, it could be due to some other cause. I'd give the Convenia a little more time to do its work.

Originally Posted by cwaters

... Her 'at rest' sleep breathing continues to be good (about 20 per minute).

That is quite an odd cough. It sounds very deep and hoarse. Coughs due to MVD typically are because of fluid in the lungs or the very enlarged heart impinging upon the breathing apparatus. So, it could be due to some other cause. I'd give the Convenia a little more time to do its work.

Freckles' CBC and kidney-related blood work came back normal. The vet is forwarding the results to the cardiologist. No mention was made of allergies.

Another set of x-rays are scheduled for this Friday--to see if the heart is still enlarged, and whether there is any fluid. The vet said that the Enalapril should help with the enlargement.

When I told the vet that the coughing hasn't improved, she said that it could be caused by the enlarged heart putting pressure on the bronchial tubes. To me, that sounds as though the Enalapril (even the increased dosage that was begun a week ago) isn't helping the condition--or, at least, not improving it.

... Another set of x-rays are scheduled for this Friday--to see if the heart is still enlarged, and whether there is any fluid. The vet said that the Enalapril should help with the enlargement.

When I told the vet that the coughing hasn't improved, she said that it could be caused by the enlarged heart putting pressure on the bronchial tubes. To me, that sounds as though the Enalapril (even the increased dosage that was begun a week ago) isn't helping the condition--or, at least, not improving it.

It's now been nine days since the Convenia has been administered.

Enalapril has been found in at least one study to somewhat reduce the size of hearts enlarged due to MVD in some dogs in CHF. However, the reduction takes a long time. Pimobendan (pimo, Vetmedin) reportedly does a better job of heart reduction in dogs in CHF, but keep in mind that your dog is not in CHF. We have had several cavaliers that have gone through CHF, and have had the cardiac cough, and it has been just another symptom of the disease. When heart enlargement has been determined to be the cause of the cough, to my knowledge there is nothing that can be done to stop the coughing short of either an ACE-inhibitor or pimo reducing the size of the heart and thereby eliminating the cause of the cough. But these reductions have not been universal (that is, for all dogs with MVD) and they are not quick (they take several weeks to months, not just days).

Freckles fortunately is not in CHF, so she should not be taking pimo (according to the ACVIM's Consensus Statement and the manufacturer's warnings and the FDA's statement approving pimo for dogs).

Enalapril has been found in at least one study to somewhat reduce the size of hearts enlarged due to MVD in some dogs in CHF. However, the reduction takes a long time. Pimobendan (pimo, Vetmedin) reportedly does a better job of heart reduction in dogs in CHF, but keep in mind that your dog is not in CHF. We have had several cavaliers that have gone through CHF, and have had the cardiac cough, and it has been just another symptom of the disease. When heart enlargement has been determined to be the cause of the cough, to my knowledge there is nothing that can be done to stop the coughing short of either an ACE-inhibitor or pimo reducing the size of the heart and thereby eliminating the cause of the cough. But these reductions have not been universal (that is, for all dogs with MVD) and they are not quick (they take several weeks to months, not just days).

Freckles fortunately is not in CHF, so she should not be taking pimo (according to the ACVIM's Consensus Statement and the manufacturer's warnings and the FDA's statement approving pimo for dogs).

Thank you for helping me to put things into perspective, Rod. As you noted, Freckles has been on Enalapril (i.e., the ACE-inhibitor) for only just over two weeks.